Aetna forcing me to "rent to own" apria or lincare

Hello all,


I have aetna ins, and a 1500 yearly ded......

anyways since I have not yet met my ded this year (just wait i am sure i will) The CPAP will basically be out of my pocket (or my HSA account)

Anyways I am looking to trade up to an APAP as I am not as rested as i would like and thinkit would help over my resmed cflex unit.

I just called aetna and they informed me that to get anything i spend at a dme to apply towards my 1500 ded that i would have to buy it through either apria, or lincare, and that it would be a rent to own monthly fee as they do not do strict buying of machines....


Is this a true policy? and if so which is better (chepaer) lincare or apria? also can I just tell apria (who i use right now) which machine I want irregardless of what they "carry" in stock?

Somewhere, I found the Aetna policy on CPAP a couple of years ago. You can find it on line by googling. With most insurance companies, it's not real if it's not in writing. So get the written policy, read it and understand it. That way, you know precisely what your options are. And when they say something different, you can shove the papers up their collective noses.

While no one can say anything for sure without seeing your specific policy, 99.9% of the time Aetna (And most other insurance companies) have xPAP equipment set up as a rental item.

Regarding which will be cheaper - it doesn't matter. The price is pre-determined by Aetna and will be the same if you go to Apria, Lincare or Bill and Ted's Excellent CPAP Supply Shack.

If you are OK with handling everything on your own you may be better off buying a machine somewhere (Online or locally) straight up for cash. Note that if you deal with a DME supplier that bills insurance they will (almost always) NOT be able to charge you less for paying cash. Most insurance companies include a stipulation in their contracts that requires a supplier to charge cash customers the same price the insurance companies have setup.

If you feel that you may want or need a local company to work with you then speak with local suppliers who are in-network and deal with whomever you feel most comfortable with.

mattman

Your situation is very similiar to my wife's. $1500 deductable and rent to own. We rented last year because the deductible had been met. The machine had been paid for 5 months as of Dec. Knowing I had 7 payments of 80 + dollars in front of me, I bought one out right from cpap.com for $475 delivered to the door. Here was my rational:
1) $475 versus $560
2) 2 year warranty vs 1.5 yrs (had the machine 6 months already).
3) DME was a local outfit that really neglected the clients.

Cpap.com was a no brainer. I did turn it in to Principal and they applied towards the out of network deductible.
It was so worth it to see the Rts face when I took back! a true Kodak moment.

Same thing happened to me. I turned in my rental and purchased outright. I haven't talked to Apria in 9 months but they still call with automated messages thinking I am still in their system.

I can't advise you on insurance or DMEs, BUT: if CPAP isn't doing the job, is there some reason you think APAP will? It would be a pretty expensive experiment unless there's a logical reason to switch. Especially if you're footing most of the bill!

The two are "different", but neither is inherently "better" than the other. It all depends on what's lacking in your current CPAP setup. I'd investigate that first.

When I called Aetna, they indicated that I had to rent as well, and the conditions were:
--had to use Apria or Lincare for in-netowrk coverage and my deductible applies (for me $1000).
--it's a rental of either 11 or 13 months (don't recall), so it will run against two annual deductibles.
They stated that if I used an out-of-network provider, then:
--my higher $2000 deductible would apply and I still would have to rent a machine.
And they said of I purchased online, the amount would not even apply to my deductible.

Now, per the two non-preferred DME's I spoke with, this is incorrect. They both said that since they are out-of-network, they have no rental billing contract with Aetna, so they bill the complete amount up front. They also indicated that the first-line customer service agents rarely, if ever, have good information on how it works.

For me, after weighing the options (I absolutely did not want to deal with Apria--my doctor even said to avoid them) I decided to buy outright from cpap.com. It was about 1/3rd the cost of using an out-of-network DME and about half of what I estimate using Apria would have been out of pocket. (And that's before adjusting for the savings since I used my FSA.

I do plan to submit the CPAP.com purchase to see if they will credit it against my deductible; I would not be surprised if the customer service agent was severely mis-informed. I may wait until after my 3-month followup with my doctor so that we can attach the compliance data with the claim.

Here's what Aetna does. rent to cap after 10 months. Each six months thereafter you are billed a maintenance and service fee which equals one months rent. What this means to the pt: you have a 2 year warranty on your unit, is anything happens in that 2 years the manufacturers warranty covers it. Years 3-5 if something happens you get another unit as you have a maintenance and service agreement.


I do have to agree with PP, why do you think an APAP will be any better??